Parents' uptake of human papillomavirus vaccines for their children: a systematic review and meta-analysis of observational studies.
Parents' uptake of human papillomavirus vaccines for their children: a systematic review and meta-analysis of observational studies.
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DOI：
10.1136/bmjopen-2017-019206
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发表时间：
2018-04-20
期刊：
影响因子：
2.9
通讯作者：
Asey F
中科院分区：
文献类型：
--
作者：
Newman PA;Logie CH;Lacombe-Duncan A;Baiden P;Tepjan S;Rubincam C;Doukas N;Asey F
研究与父母为孩子接种人乳头瘤病毒 (HPV) 疫苗相关的因素。系统回顾和荟萃分析。 Cochrane Library、AIDSLINE、CINAHL、EMBASE、PsycINFO、Social Sciences Abstracts、Ovid MEDLINE、Scholars Portal、Social Sciences Citation Index 和 Dissertation Abstracts International 从成立到 2017 年 11 月。我们纳入了对父母进行抽样并评估其子女（≤ 18 岁）HPV 疫苗接种情况和/或社会人口统计学、知识、态度或其他与接种相关因素的研究。使用有效公共卫生实践项目工具评估研究偏倚风险。我们使用随机效应荟萃分析汇总数据，并进行适度分析，以检查儿童和父母性别吸收的差异。纳入了针对 15 个国家的 840–838 名家长的 79 项研究。父母为孩子接种 HPV 疫苗的汇总比例为 41.5%（范围：0.7%–92.8%），女孩（46.5%）是男孩（20.3%）的两倍。在 62 项研究的荟萃分析中，医生建议 (r=0.46 (95% CI 0.34 至 0.56)) 对父母的接种影响最大，其次是 HPV 疫苗安全性担忧 (r=−0.31 (95% CI -0.41 至 -0.16))、过去 12 个月的常规儿童预防性检查 (r=0.22 (95% CI 0.11 至 -0.16))。 0.33)) 和父母对疫苗的信念 (r=0.19 (95% CI 0.08 至 0.29))。健康保险覆盖的 HPV 疫苗接种（r=0.16（95% CI 0.04 至 0.29））和较低的自付费用（r=−0.15（95% CI −0.22 至 −0.07））对接种有显着影响。我们发现对儿童性别有显着的调节作用。研究结果表明，HPV 疫苗的接种水平不理想，男孩的接种率低两倍，除了扩大保险覆盖范围和减少自付费用之外，还可以通过增加医生建议、解决父母安全问题、提高父母对疫苗的积极信念来改善这一情况。该荟萃分析的局限性包括缺乏干预研究以及大多数审查的研究存在较高的偏倚风险。进一步的研究应按儿童和父母的性别对 HPV 疫苗的接种情况进行分类。
To examine factors associated with parents’ uptake of human papillomavirus (HPV) vaccines for their children. Systematic review and meta-analysis. Cochrane Library, AIDSLINE, CINAHL, EMBASE, PsycINFO, Social Sciences Abstracts, Ovid MEDLINE, Scholars Portal, Social Sciences Citation Index and Dissertation Abstracts International from inception through November 2017. We included studies that sampled parents and assessed uptake of HPV vaccines for their children (≤18 years) and/or sociodemographics, knowledge, attitudes or other factors associated with uptake. Study risk of bias was assessed using the Effective Public Health Practice Project tool. We pooled data using random-effects meta-analysis and conducted moderation analyses to examine variance in uptake by sex of child and parent. Seventy-nine studies on 840 838 parents across 15 countries were included. The pooled proportion of parents’ uptake of HPV vaccines for their children was 41.5% (range: 0.7%–92.8%), twofold higher for girls (46.5%) than for boys (20.3%). In the meta-analysis of 62 studies, physician recommendation (r=0.46 (95% CI 0.34 to 0.56)) had the greatest influence on parents’ uptake, followed by HPV vaccine safety concerns (r=−0.31 (95% CI −0.41 to −0.16)), routine child preventive check-up, past 12 months (r=0.22 (95% CI 0.11 to 0.33)) and parents’ belief in vaccines (r=0.19 (95% CI 0.08 to 0.29)). Health insurance-covered HPV vaccination (r=0.16 (95% CI 0.04 to 0.29)) and lower out-of-pocket cost (r=−0.15 (95% CI −0.22 to −0.07)) had significant effects on uptake. We found significant moderator effects for sex of child. Findings indicate suboptimal levels of HPV vaccine uptake, twofold lower among boys, that may be improved by increasing physician recommendations, addressing parental safety concerns and promoting parents’ positive beliefs about vaccines, in addition to expanding insurance coverage and reducing out-of-pocket costs. Limitations of this meta-analysis include the lack of intervention studies and high risk of bias in most studies reviewed. Further studies should disaggregate HPV vaccine uptake by sex of child and parent.
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